Nonspecific Abdominal Complaints Research Articles

Mucosal Function and Breath Hydrogen Excretion: Comparative Studies in the Clinical Evaluation of Children with Nonspecific Abdominal Complaints

To evaluate the role of the lactose breath hydrogen test for the detection of lactose malabsorption in children with chronic nonspecific abdominal complaints, breath hydrogen excretion was measured in 131 children with recurrent abdominal pain (n = 75) or chronic nonspecific diarrhea (n = 56) following a lactose load (2 gm/kg; maximum 50 gm). The data were compared to those obtained from lactose tolerance tests (n = 113) and symptom response following a lactose load (n = 109) performed simultaneously with the lactose breath hydrogen test, and with results from small bowel biopsies obtained in 31 children to determine dissacharidase activity and mucosal histology. The results indicate that an increase in breath hydrogen of greater than 10 ppm above base line values (delta ppm) by 120 minutes ("early increase" response) completely discriminates between biopsy-proven isolated lactase-insufficient and lactase-sufficient children. A similar increase after 120 minutes ("late increase" response) is consistent both with normal mucosal function and partial lactase insufficiency due to mucosal injury. Breath hydrogen responses predicted assayed lactase activity in all patients with isolated lactase insufficiency, but were "falsely negative" in four of ten children whose lactase insufficiency was secondary to mucosal injury. In both clinical groups, lactose malabsorbers report significantly more symptoms than absorbers (P less than .001), but neither symptom reports nor tolerance tests are accurate methods for distinguishing lactose malabsorbers from absorbers. Although the lactose breath hydrogen test provides objective documentation of lactose malabsorption, it is equally predictive of assayed lactase activity in all clinical groups.

Detection of Bowel Lesions During Abdominal and Pelvic Sonography

ABDOMINAL and pelvic sonography are becoming more frequently used as primary screening procedures for the evaluation of nonspecific abdominal complaints. Since barium is highly reflective to ultrasound, sonography is often performed before an upper gastrointestinal tract series or barium enema examination. Bowel lesions may therefore be initially encountered during the sonographic examination. Occasionally, sonography will afford characterization of a bowel lesion even when it cannot be established radiologically.1In this article, the authors will discuss the sonographic appearance of bowel tumors and illustrate some clinical situations in which a bowel lesion was initially detected by ultrasound. The patients included in this study were selected from a larger group of 35 patients who underwent surgery and whose sonograms were indicative of a bowel lesion.2In every case, the sonogram was obtained as a screening procedure before radiological studies. A variety of bowel lesions that can be identified sonographically are

Cecal Necrosis after Open-Heart Operation

Two patients with isolated transmural ischemic necrosis of the cecum after cardiopulmonary bypass are discussed. Superimposed upon the multiple cardiovascular abnormalities in these patients, cardiopulmonary bypass adds another risk factor for nonocclusive intestinal infarction. In patients undergoing open-heart procedures, postoperative nonspecific abdominal complaints should be evaluated with a high degree of suspicion for this lethal complication. An intensive diagnostic effort is indicated, including contrast and angiographic radiological studies. Consideration of early abdominal exploration is indicated.